European Heart Journal Advance Access originally published online on May 30, 2008
European Heart Journal 2008 29(13):1662-1669; doi:10.1093/eurheartj/ehn214
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Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function
1 Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia
2 Department of Medicine, University of Melbourne, Melbourne, Australia
3 Department of Respiratory and Sleep Disorders Medicine, Western Hospital, Melbourne, Australia
4 Department of Mathematics and Statistics, University of Melbourne, Melbourne, Australia
Received 18 July 2007; revised 3 April 2008; accepted 6 May 2008; online publish-ahead-of-print 30 May 2008.
* Corresponding author. Tel: +61 3 9349 5400, Fax: +61 3 9349 5411, Email: jon.kalman{at}mh.org.au
Aims: Recent studies have suggested an emerging link between sleep apnoea and atrial fibrillation (AF). These studies included patients with reduced left ventricular (LV) function which may cause both AF and sleep disordered breathing (SDB). We examined the prevalence of SDB in a population of patients with AF and normal LV function.
Methods and results: Ninety patients with paroxysmal or persistent AF and 45 controls were prospectively enrolled and matched 2:1 for age (AF 56 ± 12 years; controls 54 ± 11years) and sex. All patients had normal LV function. SDB was diagnosed using all-night portable polysomnography. Apnoea–hypopnoea index (AHI) in AF patients was higher than in controls (23.19 ± 19.26 vs. 14.66 ± 12.43, P = 0.01). The proportion with significant SDB (AHI > 15) was also greater in AF patients (62 vs. 38%, P = 0.01). After adjustment for relevant covariates, the odds ratio for the association between AF and SDB (AHI > 15) was 3.04 (95% CI 1.24–7.46, P = 0.02). The paroxysmal AF group was classified as either ‘low-frequency AF’ (
6) or ‘high-frequency AF’ (>6) episodes in the past year. High-frequency AF was associated with a higher prevalence (75 vs. 43%, P = 0.012) and severity (mean AHI 28.08 ± 22.94 vs. 16.69 ± 15.06, P = 0.028) of SDB when compared with those with low-frequency AF.
Conclusion: A high prevalence of SDB is found in relatively young patients with both paroxysmal and persistent AF with normal LV function. This AF population warrants careful consideration for the presence of SDB.
Key Words: Atrial fibrillation • Sleep apnoea • Normal left ventricular function